Spinal Anesthesia Induced Hypotension During Cesarean Section

Phase 4

Completed

Interventions: Other: Colloid administration
Other: Crystalloid administration
Drug: phenylephrine infusion

Brief Summary: The purpose of this study is to compare two methods for preventing low blood pressure associated with spinal anesthesia during Cesarean sections.

Detailed Description: Many women experience low blood pressure after spinal anesthesia for Cesarean section. This low blood pressure may result in nausea, vomiting dizziness and impairment of uterine blood flow.The purpose of this study is to compare two methods for preventing low blood pressure associated with spinal anesthesia during Cesarean sections. In both methods, we will attempt to prevent low blood pressure using phenylephrine infusion that has been shown to be effective in recent research. In addition to receiving phenylephrine one group of patients will receive standard salt solution (Ringer's lactate solution), while the other group will receive a different, intravenous fluid called hydroxyethylstarch.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Contraindications to spinal anesthesia
Multiple gestation, placenta previa, accreta
Pregnancy induced hypertension or preeclampsia
Diabetes mellitus, cardiovascular diseases
Coagulopathy
Spinal cord abnormalities, spinal surgery, or preexisting neurological dysfunction
Baseline HR <65
Failed spinal anesthesia/inadequate sensory block for surgery
History of abnormal bleeding
History of adverse reactions to hydroxyethylstarch

Arm && Interventions

Group	Intervention	Description
colloid, then phenylephrine infusion	Colloid administration	colloid administration; with 0.5 L Hydroxyethylstarch solution at a rate of 17 ml/min and completed over 30 min. A phenylephrine infusion will be started immediately after performing the spinal anesthesia and continued until time of uterine incision.
crystalloid, then phenylephrine infusion	Crystalloid administration	crystalloid administration; The patients received 1.5 L Ringer's lactate infusion at a rate of 50 ml/min and completed over 30 min prior to spinal anesthesia for cesarean section. A phenylephrine infusion will be started immediately after performing the spinal anesthesia and continued until time of uterine incision.
colloid, then phenylephrine infusion	phenylephrine infusion	colloid administration; with 0.5 L Hydroxyethylstarch solution at a rate of 17 ml/min and completed over 30 min. A phenylephrine infusion will be started immediately after performing the spinal anesthesia and continued until time of uterine incision.
crystalloid, then phenylephrine infusion	phenylephrine infusion	crystalloid administration; The patients received 1.5 L Ringer's lactate infusion at a rate of 50 ml/min and completed over 30 min prior to spinal anesthesia for cesarean section. A phenylephrine infusion will be started immediately after performing the spinal anesthesia and continued until time of uterine incision.

Primary Outcome Measures

Name	Time	Method
Incidence of Maternal Hypotension	participants were assessed for an average of 20 min, after performing the spinal anesthetic till the delivery of the baby

Secondary Outcome Measures

Name	Time	Method
Incidence of Maternal Bradycardia	participants were assessed for an average of 20 min, after performing the spinal anesthetic till the delivery of the baby
Fetal Cord Blood pH	delivery of the baby
Dosage of Phenylephrine Used	participants were assessed for an average of 20 min, after performing the spinal anesthetic till the delivery of the baby
APGAR Scores	Apgar scores were assessed at 1 amd 5 min after delivery of the baby	The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10 with higher scores being better than lower scores. The five criteria are summarized using words chosen to form an acronym (Appearance, Pulse, Grimace, Activity, Respiration).
Incidence of Maternal Nausea and Vomiting	participants were assessed for an average of 20 min, after performing the spinal anesthetic till the delivery of the baby